Faculty Profiles - TOKUDA Yoshiyuki

CiNii Research

Clinical Features and Postoperative Mobilization following Total Aortic Arch Replacement

Shirai Yuya, Tokuda Yoshiyuki, Tsuchikawa Yohei, Kobayashi Kiyonori, Tanaka Shinya, Yoshito Natsumi, Hori Yuto, Takagi Daichi, Nishida Yoshihiro, Mutsuga Masato

International Heart Journal Vol. 65 ( 6 ) page： 1075 - 1078 2024.11

Language：English Publishing type：Research paper (scientific journal) Publisher：International Heart Journal Association

Open thoracic aortic surgery is believed to necessitate more intensive rehabilitation. This study aimed to compare the progress of postoperative rehabilitation between standard and delayed mobilization. A retrospective review was conducted on 199 patients who underwent isolated total aortic arch replacement via median sternotomy. Cases of in-hospital mortality and postoperative stroke were excluded. Based on the current guidelines for cardiovascular rehabilitation of the Japanese Circulation Society, patients were categorized into standard mobilization (could sit on the edge of bed within 2 days) and delayed mobilization (could not do so) groups. Rehabilitation progress was compared among both groups. Initial mobilization was delayed in 100 patients (delayed mobilization group), primarily because of respiratory failure (46.0%). Preoperative risk characteristics, including EuroSCORE II (median, 2.9 versus 3.5), were similar between the standard and delayed mobilization groups. The delayed mobilization group had longer operation (median, 6.1 versus 8.0 hours, P < 0.001) and cardiopulmonary bypass (median, 3.2 versus 4.1 hours, P < 0.001) times. Independent ambulation occurred earlier in the standard mobilization group (median, 6.0 versus 8.0 days, P < 0.001).In conclusion, early initiation of sitting on the edge of the bed within 2 days was associated with earlier independent ambulation during postoperative rehabilitation, which supports the current guidelines. Longer operation and cardiopulmonary bypass times were associated with delayed mobilization initiation, suggesting the need for more tailored approaches in such cases.

DOI： 10.1536/ihj.24-261

CiNii Research

Risk factors for proximal and distal aortic events after type A acute aortic dissection. Reviewed International journal

Akita S, Tokuda Y, Kato W, Tanaka K, Mutsuga M

General thoracic and cardiovascular surgery 2024.9

HeartMate 3 driveline damage by gradual corrosion due to liquid infiltration: a case report. Reviewed International journal

Yoshizumi T, Ito H, Terazawa S, Tokuda Y, Sakurai H, Narita Y, Mutsuga M

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 2024.8

Bronchial occlusion with endobronchial Watanabe spigots using a two-scope technique for massive haemoptysis. Reviewed International journal

Baba T, Ito T, Sato Y, Hayai S, Koyama J, Nakamura S, Tokuda Y, Chen-Yoshikawa TF, Ishii M

Respirology case reports Vol. 12 ( 6 ) page： e01405 2024.6

Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study. Reviewed International journal Open Access

Nagasaki K, Kobayashi H, Nishizaki Y, Kurihara M, Watari T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Katayama K, Tokuda Y

Scientific reports Vol. 14 ( 1 ) page： 1481 2024.1

Surgical reconstruction after resection of cardiac metastasis from oropharyngeal carcinoma: a case report. Reviewed International journal

Nishi T, Fujimoto KL, Hiramatsu M, Okada T, Suzuki Y, Shimoyama Y, Terazawa S, Tokuda Y, Mutsuga M, Usui A

Nagoya journal of medical science Vol. 85 ( 4 ) page： 875 - 879 2023.11

Safety culture survey among medical residents in Japan: a nationwide cross-sectional study. Reviewed International journal Open Access

Watari T, Kurihara M, Nishizaki Y, Tokuda Y, Nagao Y

BMJ open quality Vol. 12 ( 4 ) 2023.10

Phase II trial of biweekly administration with eribulin after three cycles of induction therapy in hormone receptor-positive, HER2-negative metastatic breast cancer (JACCRO BC-03). Reviewed International journal

Kobayashi K, Masuda N, Mizuno T, Miura K, Tokuda Y, Yoshinami T, Kawaguchi H, Ohtani S, Saeki T, Toi M, Takeuchi M, Ito Y

Breast cancer research and treatment Vol. 201 ( 3 ) page： 409 - 415 2023.10

Association between prolonged weekly duty hours and self-study time among residents: a cross-sectional study. Reviewed International journal

Nagasaki K, Nishizaki Y, Shinozaki T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Kurihara M, Katayama K, Kobayashi H, Tokuda Y

Postgraduate medical journal Vol. 99 ( 1176 ) page： 1080 - 1087 2023.9

Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis With a Severely Calcified Raphe Using An Under-Sized SAPIEN 3 Valve: Sizing by the Circle Method and Deployment by the Pressure-Regulated Method. Reviewed International journal

Tobe A, Tanaka A, Tokuda Y, Shirai Y, Miyazaki T, Yuhara S, Akita S, Furusawa K, Ishii H, Mutsuga M, Murohara T

Cardiovascular revascularization medicine : including molecular interventions Vol. 53S page： S149 - S152 2023.8

Hybrid Repair of Extensive Aortic Arch Aneurysms: Outcomes of Isolated Frozen Elephant Trunk Repair and of Elephant Trunk with Second Stage Thoracic Endovascular Aortic Repair. Reviewed International journal

Tokuda Y, Terazawa S, Yoshizumi T, Ito H, Banno H, Mutsuga M

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Vol. 66 ( 2 ) page： 284 - 285 2023.8

Clinical implications of the cardio-ankle vascular index before and after transcatheter aortic valve implantation. Reviewed International journal

Miki Y, Tanaka A, Tokuda Y, Tobe A, Shirai Y, Yuhara S, Akita S, Furusawa K, Ishii H, Mutsuga M, Murohara T

Journal of cardiovascular medicine (Hagerstown, Md.) Vol. 24 ( 5 ) page： 302 - 307 2023.5

Incidence and clinical impact of silent pancreatitis after aortic arch surgery. Reviewed International journal

Tsukasa Ohno, Masato Mutsuga, Shunei Saito, Yoshiyuki Tokuda, Keiichi Nagai, Norio Umemoto, Tomonobu Abe, Akihiko Usui

Asian cardiovascular & thoracic annals Vol. 31 ( 4 ) page： 303 - 311 2023.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: This study was designed to investigate the incidence and types of pancreatic injury, risk factors, and time-course changes in computed tomographic findings following total aortic arch replacement with moderate hypothermic circulatory arrest. METHODS: Medical records of patients who underwent total arch replacement between January 2006 and August 2021 were retrospectively reviewed. A comparison study between the patients with (group P) and without pancreatic injury (group N) was conducted to elucidate the impact of pancreatic injury. Follow-up computed tomography of the patients in group P was reviewed to investigate time-course changes of the pancreatic injury. RESULTS: Of 353 patients, 14 (4.0%) had subclinical pancreatic injury. Computed tomographic findings were consistent with acute pancreatitis in all patients, of whom eight patients had interstitial edematous pancreatitis, whereas six patients had necrotizing pancreatitis. Although walled-off necrosis occurred in three patients, none of them required drainage. In-hospital mortality was 7.1% and 4.4% in groups P and N, respectively (p = 0.98). The 5-year actuarial survival rates were 77.9% and 81.0% in groups P and N, respectively (p = 0.51). Multivariate analysis revealed that pancreatic injury was associated with chronic obstructive pulmonary disease (p = 0.03). CONCLUSIONS: This study highlighted that silent pancreatic injury after aortic arch surgery is underrecognized. Potential arterial sclerosis of the pancreatic circulation seems to be related to pancreatic injury.

DOI： 10.1177/02184923231158581

冠動脈バイパス手術患者における早期歩行が長期予後に与える影響 Reviewed International journal

土川洋平, 徳田順之, 伊藤英樹, 清水美帆, 田中伸弥, 西田一貴, 高木大地, 福田章真, 武田夏季, 山本浩正, 堀将也, 西田佳弘, 六鹿雅登

日本循環器学会学術集会抄録集 Vol. 87回 page： CA1 - 5 2023.3

Impact of an improved driveline management for HeartMate II and HeartMate 3 left ventricular assist devices. Reviewed International journal

Masato Mutsuga, Takahiro Okumura, Ryota Morimoto, Toru Kondo, Hideki Ito, Sachie Terazawa, Yoshiyuki Tokuda, Yuji Narita, Kazuki Nishida, Toyoaki Murohara, Akihiko Usui

Artificial organs Vol. 47 ( 2 ) page： 387 - 395 2023.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: We evaluated the impact of a standardized driveline care strategy, including a subfascial-tunneling method and dressing protocol, on the incidence of driveline infection (DLI). METHODS: DLI data from all HeartMate II (HMII) and HeartMate 3 (HM3) patients (including exchange devices) were retrospectively collected between 2013 and 2021. The driveline subfascial-tunneling method was altered in three steps (A: right direct; B: left triple, C: right triple), and the shower protocol was changed in two steps (A: with/without cover, B: with cover). Disinfection was individually tailored after changing the shower protocol. Complications associated with morbidity and mortality were evaluated for each modification. RESULTS: During the study period, 80 devices were implanted (HMII, n = 54; HM3, n = 26). The 8-year incidence of DLI was 15% (n = 8) in HMII patients and 0% in HM3 patients (p = 0.039). DLI was not associated with hospital mortality. The modified dressing protocol and tunneling method was associated with a significantly better DLI incidence rate in comparison to the previous one: Protocol-A (n = 17), Protocol-B (n = 63), 35% vs 3% (p = 0.0009), Method-A (n = 13), Method-B (n = 42), Method-C (n = 25), 46% vs 5% vs 0% (p = 0.0001). The rete of freedom form DLI at 1, 2, and 3 years had also significant difference between groups: Protocol-A and Protocol-B, 80%, 54%, 54% vs 96%, 96%, 96%, respectively (p < 0.0001), Method-A, Method-B and Method-C, 76%, 44%, 44%, vs 94%, 94%, 94% vs 100%, 100%, respectively (p < 0.0001). CONCLUSIONS: A standardized triple driveline tunneling strategy and waterproof dressing protocol reduced driveline infection in HM3 patients to 0%.

DOI： 10.1111/aor.14426

Impact of Early Ambulation on the Prognosis of Coronary Artery Bypass Grafting Patients Open Access

Tsuchikawa Yohei, Tokuda Yoshiyuki, Ito Hideki, Shimizu Miho, Tanaka Shinya, Nishida Kazuki, Takagi Daichi, Fukuta Akimasa, Takeda Natsuki, Yamamoto Hiromasa, Hori Masaya, Nishida Yoshihiro, Mutsuga Masato

Circulation Journal Vol. 87 ( 2 ) page： 306 - 311 2023.1

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background: The effect of delayed ambulation on the outcome of coronary artery bypass grafting (CABG) remains to be clarified.Methods and Results: The long-term and in-hospital outcomes of 887 patients who underwent isolated CABG (455 off-pump cases, 135 urgent cases) were evaluated, with a focus on the timing of first ambulation. In-hospital mortality cases were excluded. Early ambulation (first ambulation within 3 days after operation) was achieved in 339 (38%) patients. In the multivariable logistic regression analysis, longer operation time and urgent case, EuroSCORE II, re-thoracotomy, and respiratory time were associated with delayed (≥4 days) ambulation. Delayed ambulation was associated with a high incidence of postoperative complications, such as pneumonia, and stroke (P<0.01). Following discharge, 22.2% of patients experienced major cardiac events and 13.8% died during the follow-up period (median follow-up 60 months). Cox hazards analysis revealed that delayed ambulation was associated with long-term adverse events (hazard ratio 1.04 per day, P<0.001). With adjustment for preoperative factors, the estimated future risk of adverse events was found to be increased day-by-day during the delay until initial ambulation.Conclusions: In isolated CABG patients, delayed ambulation was associated with poor outcomes, even in the long-term period. The results support the current guideline recommending early ambulation protocol after cardiac surgery.

DOI： 10.1253/circj.CJ-22-0416

Impact of Albuminuria on the Prognosis After Transcatheter Aortic Valve Implantation. Reviewed International journal

Tobe A, Tanaka A, Tokuda Y, Shirai Y, Miyazaki T, Yuhara S, Akita S, Furusawa K, Ishii H, Mutsuga M, Murohara T

The American journal of cardiology Vol. 186 page： 156 - 162 2023.1

Language：English Publishing type：Research paper (scientific journal) Publisher：American Journal of Cardiology

The impact of preoperative albuminuria on the prognosis after transcatheter aortic valve implantation (TAVI) has not been studied. A total of 228 patients who underwent TAVI for severe aortic stenosis (AS) and for whom preoperative urinary data was available were retrospectively investigated. Patients were divided into two groups according to the urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR<30 mg/g). The urinary total protein-to-creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was the composite outcome of all-cause death and readmission for heart failure. In total, 117 patients had a high ACR and 111 patients had a low ACR. During the median follow-up period of 467 days, patients with a high ACR had a higher incidence of the primary outcome than those with a low ACR (p<0.001). Patients with a high PCR or positive dipstick proteinuria were also at a higher risk for the primary outcome (p<0.001 and p=0.008, respectively). Multivariable Cox proportional hazards analysis showed a high ACR was independently associated with a primary outcome (hazard ratio, 4.98; 95% confidence interval, 1.84–13.49; p=0.002). In conclusion, preoperative albuminuria is an independent predictor of cardiac events in patients with severe AS undergoing TAVI.

DOI： 10.1016/j.amjcard.2022.09.020

Higher F-wave frequency associates with poor procedural success rate after Maze procedure. Reviewed International journal

Usui R, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Inden Y, Murohara T, Usui A

General thoracic and cardiovascular surgery Vol. 70 ( 12 ) page： 997 - 1004 2022.12

Language：English Publishing type：Research paper (scientific journal) Publisher：General Thoracic and Cardiovascular Surgery

Objectives: Persistent atrial fibrillation (AF) causes atrial remodeling, which causes myocardial fibrosis and micro-reentry. Fibrosis may reduce wave voltage and micro-reentry may enhance the dominant frequency (DF) of the F-wave. We investigated whether the DF predicts procedural success by the Maze procedure. Methods: In 138 consecutive patients who underwent mitral valve surgery and a modified Cox-Maze III procedure for persistent AF in Nagoya University in 2002–2018, 96 (70%) were successfully cardioverted (group S); 42 had persistent or relapsed AF after surgery (group F). Patient data were compared between the groups. Cut-off values were determined by an ROC analysis and predictors of procedural success were evaluated. The DF was obtained from the F-wave of V1 by a high-speed Fourier analysis using the CEPAS software program. Results: Group F showed a significantly larger LA diameter, better LVEF, lower F-wave voltage, higher DF, and longer duration of AF. The cut-off values were as follows: LA diameter, 56 mm; EF, 64.5%; F-wave voltage, 0.13 mV; DF, 7.3 Hz; and duration of AF, 44 months. Each factor showed statistical significance in a univariate analysis; DF lost significance in the multivariate analysis. The higher (DF ≥ 7.3 Hz) and lower voltage group (≤ 0.13 mV) showed the worst procedural success rate (36%), while the lower DF (< 7.3 Hz) and higher voltage group (> 0.13 mV) showed a good rate (86%). Conclusions: The DF of the F-wave is a useful predictor of procedural success after the Maze procedure in addition to the voltage of F-wave.

DOI： 10.1007/s11748-022-01836-0

Albuminuria predicts short-term worsening renal function after transcatheter aortic valve replacement Reviewed International journal Open Access

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Yoshinori Shirai, Satoshi Otsuka, Toshikuni Yamamoto, Masayoshi Tokoro, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

Cardiovascular Revascularization Medicine Vol. 42 page： 178 - 181 2022.9

Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus. Reviewed International journal

Yano D, Yokoyama Y, Tokuda Y, Kato M, Mashiko Y, Kuwabara F, Ebata T, Usui A

Surgery today Vol. 52 ( 7 ) page： 1016 - 1022 2022.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Surgery Today

Purposes: The optimal surgical management of renal cell carcinoma with tumor thrombus within the inferior vena cava (IVC) remains to be clarified. Methods: Sixteen consecutive cases were reviewed. Incision, the IVC clamping position, and the venous drainage procedure were modified according to the tumor thrombus extension level: level I or II (below the hepatic vein, n = 8), level III (above the hepatic vein but below the right atrium, n = 5), and level IV (extending into the right atrium, n = 3). Results: For level I or II, resection could be simply achieved by clamping the IVC below the hepatic vein, without hemodynamic collapse. For level III, clamping the IVC above the hepatic vein and the hepatoduodenal ligament was required. Venous drainage from the lower body (cannulation to distal IVC) and portal system (cannulation to ileocolic vein) were applied. When opening the IVC, the significant backflow was controlled using cardiopulmonary bypass with drop-in suckers. For level IV, median sternotomy, exposure of the right atrium, and cardiopulmonary bypass were mandatory. With the combination of these approaches, the perioperative mortality rate was 0% and the 5-year overall survival rate was 52%. Conclusions: A multidisciplinary surgical approach is essential, especially for level III and IV cases.

DOI： 10.1007/s00595-021-02415-1

Large interventricular membranous septal aneurysm renders the anatomy unsuitable for transcatheter aortic valve replacement. Reviewed International journal

Shirai Y, Tanaka A, Tokuda Y, Tobe A, Furusawa K, Usui A, Murohara T

Journal of cardiac surgery Vol. 37 ( 7 ) page： 2103 - 2104 2022.7

Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study. Reviewed International journal Open Access

Nagasaki K, Nishizaki Y, Shinozaki T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Kurihara M, Kataoka K, Tokuda Y, Kobayashi H

Scientific reports Vol. 12 ( 1 ) page： 10626 2022.6

Albuminuria predicts worsening renal function after transcatheter aortic valve replacement Reviewed International journal Open Access

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Taro Fujii, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

Journal of Cardiology Vol. 79 ( 5 ) page： 648 - 654 2022.5

Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan: a retrospective observational study. Reviewed International journal Open Access

Kurihara M, Kamata K, Tokuda Y

BMJ open Vol. 12 ( 4 ) page： e054246 2022.4

Predictors of Failure of Mitral Valve Repair Using Artificial Chordae. Reviewed International journal Open Access

Masato Mutsuga, Yuji Narita, Yoshiyuki Tokuda, Wataru Uchida, Hideki Ito, Sachie Terazawa, Masato Nakaguro, Akihiko Usui

The Annals of thoracic surgery Vol. 113 ( 4 ) page： 1136 - 1143 2022.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: We investigated predictors of failure of mitral valve repair (MVr) using expanded polytetrafluoroethylene (ePTFE) and its durability in the long term in a single institution. METHODS: Four hundred twenty-one consecutive patients with primary mitral valve disease underwent MVr using artificial chordae (group A, n = 304) and suture repair (group S, n = 117) at our institution from January 2002 to April 2020. A comparison study was performed to examine the long-term outcomes, reoperation rate, and risk factors for reoperation. RESULTS: One hospital death and 5 late deaths occurred in group S, and 20 late deaths occurred in group A. The reoperation rates were similar: group A, n = 8 (2.6%); and group S, n = 6 (5%). The major cause of reoperation was ruptured ePTFE (CV-4, n = 1; CV-5, n = 6) in group A, and suture rupture in group S. Reoperation was performed after a median of 88 months for ruptured ePTFE, and 26 months for group S. The rate of ePTFE rupture was 1.8% with CV-5 and 0.2% with CV-4. Risk factors for reoperation included postoperative arrhythmia, urgent operation, no annular ring, ruptured ePTFE, and suture rupture. The rates of freedom from reoperation and actuarial mitral valve survival rates at 5, 10, and 15 years were 99%, 95%, and 93% and 96%, 91%, and 89%, respectively, in group A; and 96%, 91%, and 91% and 95%, 94%, and 94%, respectively, in group S. CONCLUSIONS: The long-term surgical outcomes of MVr using both techniques were feasible. Over the long term, the ePTFE rupture rate of CV-5 was higher than that of CV-4.

DOI： 10.1016/j.athoracsur.2021.04.084

Computed tomography imaging using split-bolus contrast injection with volume scan of aortic root and heart for preoperative evaluation of transcatheter aortic valve implantation Reviewed International journal

Hitomi Koyanagi, Yoshinori Tsutsumi, Yoshiyuki Tokuda, Akihito Tanaka, Maki Endo, Yasushi Furukawa, Shinji Abe

Heart and Vessels Vol. 37 ( 1 ) page： 132 - 141 2022.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Japan

The purpose of this study was to investigate using split-bolus contrast injection (SPBI) with volume scanning of the heart and aortic root with helical scanning of the access route, compared to single bolus contrast injection (SI) with variable helical pitch scanning (VHP) of the heart and aortic root and access route in a preoperative evaluation before transcatheter aortic valve implantation (TAVI). Thirty-five patients who underwent preoperative CT before TAVI using SPBI (contrast media: 24.5 mgI /kg/s, injected for 12 s for heart scan and then injected for 8 s for access route) were examined. Electrocardiogram (ECG) gated scans of the heart were performed by volume scan, after a period of time, non-gated helical scans of the aorto-iliac were performed (SPBI method). For comparison, 40 patients who had a single bolus injection (26.5 mg I/kg/s, injected for period of the scan time plus 3 s) and a VHP scan (SI method) before the SPBI method was performed were included in the study. The image qualities of the coronary arteries, aortic root, and access route (aorta-iliac), as well as radiation and iodine doses, were assessed. In visual assessment, image quality of coronary artery was significantly better with the SPBI method (grade
excellent: 57.1% in SPBI vs. 24.3% in SI, p = 0.03). There was no significant difference in image quality of the aortic root by visual assessment. The signal-to-noise (SNR) and contrast-to-noise ratio (CNR) of coronary and aortic root were not significantly different between the two methods. The access route showed significantly higher SNR (45.7 ± 11.5 vs. 34.3 ± 9.8, p &lt
0.001) and CNR (36.0 ± 9.7 vs. 28.0 ± 8.8, p &lt
0.001) for the SPBI method. The SPBI method compared to SI method reduced iodine dose by 10% and radiation dose by 45%. Preoperative CT imaging before TAVI using SPBI with volume scan is useful and can reduce iodine and radiation doses.

DOI： 10.1007/s00380-021-01899-8

Alternative therapeutic strategy for existing aortic aneurysms using mesenchymal stem cell-derived exosomes. Reviewed International journal

Kozakai M, Narita Y, Yamawaki-Ogata A, Fujimoto KL, Mutsuga M, Tokuda Y, Usui A

Expert opinion on biological therapy Vol. 22 ( 1 ) page： 95 - 104 2022.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Expert Opinion on Biological Therapy

Background: Several studies demonstrated the therapeutic potential of mesenchymal stem cell–derived exosomes (MSC-exs) based on their anti-inflammatory properties. The objective was to determine the therapeutic effects of MSC-exs on aortic aneurysms (AAs) caused by atherosclerosis. Research design and methods: Apolipoprotein E knockout mice with AAs induced by angiotensin II were injected with MSC-exs or saline as a control. The change in the diameter of the aorta was measured. The expression of AA-related proteins and the histology of the aortic wall were investigated at 1 week after treatment. MicroRNA and protein profiles of MSC-exs were examined. Results: MSC-exs significantly attenuated AA progression (2.04 ± 0.20 mm in the saline group and 1.34 ± 0.13 mm in the MSC-ex group, P = 0.004). In the MSC-ex group, the expression of IL-1β, TNF-α and MCP-1 decreased, and expression of IGF-1 and TIMP-2 increased. MSC-ex induced the M2 phenotype in macrophages and suppressed the destruction of the elastic lamellae in the aortic wall. MSC-exs contained high levels of 10 microRNAs that inhibit AA formation and 13 proteins that inhibit inflammation and promote extracellular matrix synthesis. Conclusions: MSC-ex might be a novel alternative therapeutic tool for treatment of existing AAs.

DOI： 10.1080/14712598.2022.2005575

Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients. Reviewed

Nationwide survey on Japanese residents' experience with and barriers to incident reporting. Reviewed International journal Open Access

Kurihara M, Watari T, Rohde JM, Gupta A, Tokuda Y, Nagao Y

PloS one Vol. 17 ( 12 ) page： e0278615 2022

Multiple giant coronary artery aneurysms with extended coronary ectasia emerging 12 years after previous coronary artery bypass grafting. Reviewed International journal Open Access

Fujii T, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Yuhara S, Usui A

SAGE open medical case reports Vol. 10 page： 2050313X221116681 2022

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Yusuke Miki, Kenji Furusawa, Sho Akita, Taro Fujii, Yoshinori Tsutsumi, Hideki Ishii, Shingo Iwano, Shinji Naganawa, Akihiko Usui, Toyoaki Murohara

Heart and vessels Vol. 36 ( 12 ) page： 1911 - 1922 2021.12

Language：English Publishing type：Research paper (scientific journal)

Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19-40) days vs. 27 (19-43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223-805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.

DOI： 10.1007/s00380-021-01875-2

Incident reporting among physicians-in-training in Japan: A national survey. Reviewed International journal Open Access

Kurihara M, Nagao Y, Tokuda Y

Journal of general and family medicine Vol. 22 ( 6 ) page： 356 - 358 2021.11

Sudden circulatory collapse caused by mechanical obstruction of the left main coronary trunk with infective endocarditis vegetation: a case report. Open Access

Usui R, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Usui A

Surgical case reports Vol. 7 ( 1 ) page： 223 2021.10

Hypofibrinogenemia can be estimated by the predictive formula in aortic surgery. Reviewed

Toshihiko Nishi, Masato Mutsuga, Toshiaki Akita, Yuji Narita, Kazuro Fujimoto, Yoshiyuki Tokuda, Kazuki Nishida, Shigeyuki Matsui, Kimitoshi Nishiwaki, Akihiko Usui

General thoracic and cardiovascular surgery Vol. 69 ( 10 ) page： 1376 - 1382 2021.10

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Aortic surgery often causes massive bleeding due to hypofibrinogenemia. Predicting hypofibrinogenemia is useful for developing a hemostasis strategy, including preparing for blood transfusion. We made a formula for predicting the serum fibrinogen level (SFL) at the termination of cardiopulmonary bypass (CPB) in aortic surgery and examined its validity. METHODS: We performed a retrospective observational study that consisted of 267 patients (group A) who underwent aortic surgery from July 2013 to December 2016 and made a formula for predicting the SFL at the termination of CPB in group A by a multiple linear regression analysis. The validity of this formula was then examined in another 60 patients (group B) who underwent aortic surgery from January 2017 to December 2017. RESULTS: We developed the following predictive formula: SFL at the termination of CPB (mg/dL) = 14.7 + 0.44 × preoperative SFL (mg/dL) + (- 0.14) × CPB time (min) + 0.64 × preoperative body weight (kg) + (- 17.3) × lateral thoracotomy (Yes/No, Yes: 1, No: 0). In group B, the predictive formula proved to be statistically valid in group B (R2 = 0.531, p < 0.001). CONCLUSION: The SFL at the termination of CPB in aortic surgery can be predicted by the preoperative SFL, body weight, CPB time and surgical approach. The predictive formula is useful for developing a hemostasis strategy, including preparing for blood transfusion.

DOI： 10.1007/s11748-021-01594-5

Improvement in the nutritional status after transcatheter aortic valve implantation Reviewed International journal Open Access

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Sho Akita, Yusuke Miki, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

Journal of Cardiology Vol. 78 ( 3 ) page： 250 - 254 2021.9

Worsening renal function after transcatheter aortic valve replacement and surgical aortic valve replacement. Reviewed International journal

Tobe A, Tanaka A, Tokuda Y, Nishi T, Miki Y, Furusawa K, Ishii H, Usui A, Murohara T

Heart and vessels Vol. 36 ( 7 ) page： 1080 - 1087 2021.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Heart and Vessels

Several prior reports have investigated worsening renal function around transcatheter aortic valve replacement (TAVR) procedures. However, in clinical practice, it seems more important to evaluate changes associated with TAVR-related procedures, including preoperative enhanced computed tomography (CT), as well as the TAVR procedure itself, as CT assessment is considered essential for safe TAVR. This study evaluated worsening renal function during the TAVR perioperative period, from the preoperative enhanced CT to 1 month after TAVR, and then compared the incidence with that in patients undergoing surgical aortic valve replacement (SAVR). This retrospective single-center study investigated 123 TAVR patients and 130 SAVR patients. We evaluated baseline renal function before enhanced CT in TAVR patients and before operation in SAVR patients, and again at 1 month post-operatively. We defined worsening renal function at 1 month according to three definitions: (1) an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline or initiation of dialysis, (2) a decline in eGFR at 1 month ≥ 20% from baseline or initiation of dialysis, (3) a decline in eGFR at 1 month ≥ 30% from baseline or initiation of dialysis. TAVR patients were significantly older and had higher surgical risk scores than SAVR patients. In TAVR patients, serum creatinine levels were 1.00 ± 0.32 mg/dL at baseline and 1.01 ± 0.40 mg/dL at 1 month post-operatively (p = 0.58), while in SAVR patients, these levels were 0.99 ± 0.51 mg/dL and 0.98 ± 0.49 mg/dL, respectively (p = 0.59). In TAVR patients, 7 (5.7%), 14 (11.4%), and 3 (2.4%) patients experienced worsening renal function according to the three definitions, respectively, but there were no significant differences from those in SAVR patients, for any definition. Worsening renal function after TAVR was uncommon, and the incidence rate was comparable to that in SAVR patients, even though TAVR patients had worse baseline characteristics.

DOI： 10.1007/s00380-021-01778-2

Web of Science

Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis International journal Open Access

Tobe Akihiro, Tanaka Akihito, Tokuda Yoshiyuki, Akita Sho, Fujii Taro, Miki Yusuke, Furusawa Kenji, Ishii Hideki, Usui Akihiko, Murohara Toyoaki

Circulation Journal Vol. 85 ( 7 ) page： 1093 - 1098 2021.6

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background:The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve implantation (TAVI) are not fully elucidated.Methods and Results:The study group included 64 patients who underwent TAVI for aortic stenosis. Their 12-lead ECGs before and at 2 days and 1, 6 and 12 months after TAVI were analyzed, and ECG-LVH was evaluated using various definitions. Values and prevalence of each ECG-LVH parameter significantly decreased between 1 and 6 months after TAVI. Values of ECG-LVH parameters decreased especially in patients with ECG-LVH at baseline.Conclusions:Regression of ECG-LVH was observed between 1 and 6 months after TAVI.

DOI： 10.1253/circj.CJ-21-0354

Midterm Outcomes of Zone 0 Antegrade Endograft Implantation During Type I Hybrid Aortic Arch Repair. Reviewed International journal Open Access

Hiroshi Banno, Masato Mutsuga, Masayuki Sugimoto, Yoshiyuki Tokuda, Akio Kodama, Akihiko Usui, Kimihiro Komori

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Vol. 61 ( 6 ) page： 938 - 944 2021.6

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Type I hybrid arch repair has become popular as a procedure that is less invasive than total arch replacement. The major advantage of this technique is that antegrade endograft implantation can be performed during the procedure, thereby avoiding the complications of introducing the endograft from the groin. The aim of this study was to assess the midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation. METHODS: Thirty consecutive patients who underwent type I hybrid repair with antegrade endograft implantation from 2009 to 2015 were reviewed retrospectively. Patient demographics, and peri-operative and late results were collected from a prospective database and analysed. RESULTS: Four patients (13%) were female and the median age was 78 years. Median aneurysm size was 64 mm. Six patients (20%) developed stroke, and the 30 day mortality rate was 3%. Two patients suffered aortic dissection at the site of debranching anastomosis. The median follow up was 5.2 years. All aneurysms remained stable or had decreased in size at three years, and 82% were stable at five years. Overall survival was 79% at three years and 71% at five years. The rates of freedom from aorta related death were 86% at three and five years, respectively. During the follow up period, three additional left subclavian artery embolisations and one endograft relining due to type IIIb endoleak were required. CONCLUSION: Midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation for aortic arch aneurysms are reported. Although the incidence of peri-operative stroke was high, late sac behaviour was acceptable.

DOI： 10.1016/j.ejvs.2021.02.044

Is Hybrid Repair for an Entire Shaggy Aorta Feasible? Reviewed International journal

Masato Mutsuga, Yoshiyuki Tokuda, Yuji Narita, Sachie Terazawa, Hideki Ito, Akihiko Usui

Heart Lung and Circulation Vol. 30 ( 5 ) page： 765 - 772 2021.5

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier Ltd

Objective: This paper reviewed clinical experiences to evaluate the feasibility of a surgical strategy for an entire shaggy aorta. Methods: Fifty-two (52) surgeries (47 men, average age 72±7 years) were performed for an entire shaggy aorta at the current institution from 2002–2017. Open surgery was performed in 30 cases, including total arch replacement in 12, extended aortic arch replacement via L-shaped thoracotomy in 10 and median sternotomy combined with left thoracotomy in two, and thoracoabdominal aortic replacement in six. Hybrid procedures were performed in 22 cases: type I hybrid arch repair in six, type II hybrid arch repair in seven and type III hybrid arch repair in nine. Results: Hospital mortality was significantly higher with a hybrid repair: surgical, one case (3%)
hybrid, six cases (27%), (p=0.0125). Stroke occurred at relatively high rates in both groups: surgical, seven cases (23%)
hybrid, six cases (27%) (p=0.75). Spinal cord injury was significantly higher in hybrid repair: surgical, one case (3%)
hybrid, seven cases (32%), (p=0.004). Open surgery revealed a better long-term survival rate than the hybrid procedure at 5 and 10 years: surgical, 82%, 65.7%
hybrid, 53%, 35.1%, respectively (p=0.0452). The rate of freedom from aortic events was significantly better with open surgery than a hybrid procedure at 5 and 10 years: surgical, 96%, 85%
hybrid, 83%, 41.3%, respectively (p=0.0082). Conclusions: Surgery for an entire shaggy aorta was frequently associated with embolic complications such as stroke, paraplegia, renal failure, and bowel necrosis. However, open surgical repair may produce better early and late outcomes and freedom from aortic events compared with hybrid repair.

DOI： 10.1016/j.hlc.2020.09.923

Surgery for anomalous papillary muscle directly into the anterior mitral leaflet. Reviewed International journal

Masato Mutsuga, Yoshiyuki Tokuda, Kazuro Fujimoto, Sachie Terazawa, Hideki Ito, Yuji Narita, Akihiko Usui

The Annals of thoracic surgery Vol. 111 ( 5 ) page： 1512 - 1518 2021.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The anomalous insertion of papillary muscle directly into the anterior mitral leaflet is a rare congenital anomaly concomitant with hypertrophic cardiomyopathy. We herein report our surgical technique, which is designed to relieve left ventricular obstruction and preserve the mitral valve and sub-valvular apparatus. METHODS: Among 38 patients who underwent septal myectomy from 2007 to 2020, 4 had an anomalous mitral sub-valvular apparatus with papillary muscle with direct insertion into the anterior mitral leaflets. In all cases, mitral valve repair was accomplished with excision and reconstruction of all anomalous PMs, concomitant with septal myectomy. In other 34 patients, 20 cases needed mitral valve repair with regards to systolic anterior motion by hypertrophic cardiomyopathy. The comparison study was conducted between anomalous papillary muscle group (group A) and the others (group B). RESULTS: There was no early or late death in group A, three early death and two late death in group B. The mean peak gradient in the left ventricle was significantly decreased in both groups. Mitral valve regurgitation grade was also significantly decreased from 3 to 0.5 without valve replacement in group A, from 2 to 0.6 in group B. Six patients needed mitral valve replacement due to the thickness of anterior mitral leaflet in group B. CONCLUSIONS: Hypertrophic obstructive cardiomyopathy associated with the anomalous insertion of papillary muscle can be successfully treated without mitral valve replacement. Excision and reconstruction with the anomalous papillary muscle seems to be a feasible operation to reduce mitral regurgitation and relieve outflow tract obstruction.

DOI： 10.1016/j.athoracsur.2020.07.031

Beating-heart total arch replacement for an octogenarian patient with severe heart failure Reviewed International journal Open Access

Masato Mutsuga, Hiroshi Banno, Yoshiyuki Tokuda, Akihiko Usui

Journal of Cardiac Surgery Vol. 36 ( 3 ) page： 1126 - 1129 2021.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Blackwell Publishing Inc.

Surgical outcomes of total arch replacement (TAR) have improved dramatically over the last decades. However, patients of advanced age and with a severely reduced cardiac function and an extended aortic arch aneurysm may not be candidates for conventional TAR. Endovascular and hybrid treatment for extended aortic aneurysm have demonstrated lower mortality and morbidity, and considered for the advanced age and high-risk patients. But endovascular with total de-branching technique remains challenging with the slightly dilated ascending aorta. Reducing the operation time, cardiac arrest time, and circulatory arrest time should be needed to resolve the problem for the conventional TAR with an advanced age and a severely reduced cardiac function. We herein introduce our surgical technique for the case of an 84-year-old man with a severely reduced cardiac function, who was successfully treated with beating heart TAR with minimization of the operation time, cardiac arrest time, and circulatory arrest time.

DOI： 10.1111/jocs.15282

Sutures on the Anterior Mitral Leaflet to Prevent Systolic Anterior Motion Reviewed International journal Open Access

Yoshiyuki Tokuda, Kazuro Fujimoto, Yuji Narita, Masato Mutsuga, Akihiko Usui

Annals of Thoracic Surgery Vol. 111 ( 3 ) page： e213 - e215 2021.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier Inc.

Mitral valve systolic anterior motion and associated regurgitation remain a challenging problem in mitral valve plasty. A simple procedure to correct intraoperative systolic anterior motion using sutures applied between the tip of the anterior leaflet and the posterior annulus is presented. This technique reduces the movement of the anterior leaflet toward the septum while maintaining sufficient valve orifice area.

DOI： 10.1016/j.athoracsur.2020.07.057

Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients: predictors of in-hospital mortality and failure to be weaned from extracorporeal membrane oxygenation. Reviewed

Perioperative D-dimer levels after transcatheter aortic valve replacement: Comparison of patients with and without anticoagulant therapy Reviewed International journal Open Access

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Toshihiko Nishi, Yusuke Miki, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

Cardiology Journal Vol. 28 ( 1 ) page： 170 - 172 2021

Upper thoracoabdominal aortic repair through partial posterior incision of the diaphragm via left thoracotomy Reviewed International journal

Hideki Ito, Masato Mutsuga, Yoshiyuki Tokuda, Akihiko Usui

General Thoracic and Cardiovascular Surgery Vol. 68 ( 12 ) page： 1594 - 1595 2020.12

Serial Images of Aortic Plaque Rupture During Transfemoral Transcatheter Aortic Valve Replacement Reviewed International journal

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Sho Akita, Yusuke Miki, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

JACC: Cardiovascular Interventions Vol. 13 ( 22 ) page： e203 - e204 2020.11

Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement International journal Open Access

Nishi Toshihiko, Tokuda Yoshiyuki, Tanaka Akihito, Furusawa Kenji, Miki Yusuke, Tobe Akihiro, Murohara Toyoaki, Usui Akihiko

Circulation Reports Vol. 2 ( 11 ) page： 701 - 702 2020.10

大動脈手術後後の急性腎機能障害の危険因子に対する検討 Reviewed International journal

大野司, 秋田利明, 成田裕司, 六鹿雅登, 藤本和朗, 徳田順之, 寺澤幸枝, 伊藤英樹, 内田亘, 松村泰基, 宗像寿祥, 芦田真一, 西俊彦, 秋田翔, 矢野大介, 阿部知伸, 碓氷章彦

日本胸部外科学会定期学術集会 Vol. 73回 page： CLO7 - 7 2020.10

Yuji Mashiko, Tomonobu Abe, Yoshiyuki Tokuda, Hideki Oshima, Akihiko Usui

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs Vol. 23 ( 3 ) page： 225 - 232 2020.9

Language：English Publishing type：Research paper (scientific journal)

Postcardiotomy cardiogenic shock (PCCS) is a rare clinical entity associated with substantial morbidity and mortality. It is characterized by heart failure that results in an inability to be weaned from cardiopulmonary bypass (CPB). The aim of this study was to analyze the outcomes of extracorporeal membrane oxygenation (ECMO) in patients with PCCS and to identify predictors of in-hospital mortality and failure to be weaned from ECMO. From January 2002 to August 2016, 3248 patients underwent cardiac surgery in our hospital. Of these, 29 patients (0.89%) required ECMO because of an inability to be weaned from cardiopulmonary bypass. The median duration of ECMO support was 144 h (340-52 h) (range 17-818 h). Sixteen patients (55.2%) were weaned from ECMO, and 6 (20.7%) survived to hospital discharge. The multivariate analysis revealed that reoperation [odds ratio (OR): 13.667, 95% confidence interval (CI): 0.999-187.056, p = 0.05] and ECMO support duration > 130 h (OR: 17.688, 95% CI: 1.324-236.233, p = 0.03) were independent predictors of failure to be weaned from ECMO. Temporarily being weaned from CPB > 15 min (OR: 0.027, 95% CI: 0.001-0.586, p = 0.02) was found to be a protective factor. The multivariate analysis revealed that CPB time > 270 min (OR: 12.503, 95% CI: 1.058-147.718, p = 0.05) and ECMO support duration > 60 h (OR: 12.503, 95% CI: 1.058-147.718, p = 0.05) were independent predictors of in-hospital mortality. ECMO is an acceptable technique for treating PCCS in patients undergoing cardiac surgery. Our data suggest a reevaluation of therapeutic strategies after 60 h and again after 130 h of ECMO support.

DOI： 10.1007/s10047-020-01160-5

Correction to: Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients: predictors of in‑hospital mortality and failure to be weaned from extracorporeal membrane oxygenation. Reviewed Open Access

Yuji Mashiko, Tomonobu Abe, Yoshiyuki Tokuda, Hideki Oshima, Akihiko Usui

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs Vol. 23 ( 3 ) page： 233 - 233 2020.9

Modified sutureless repair using left atrial appendage flap for acquired left-sided pulmonary vein stenosis Reviewed International journal Open Access

Hideki Ito, Masato Mutsuga, Yoshiyuki Tokuda, Akihiko Usui

European Journal of Cardio-Thoracic Surgery Vol. 58 ( 2 ) page： 395 - 397 2020.8

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press (OUP)

<title>Abstract</title>
Pulmonary vein stenosis is a well-known complication after radiofrequency catheter ablation of atrial fibrillation. Although surgical repair is indicated for younger patients and patients with multiple stenoses, the appropriate procedure for acquired pulmonary vein stenosis has not been established. In this study, we report the successful outcome of our modified sutureless technique using a left atrial appendage flap for left-sided pulmonary vein stenosis after radiofrequency catheter ablation.

DOI： 10.1093/ejcts/ezaa032

Bilateral versus single internal thoracic artery grafting in hemodialysis patients Reviewed International journal

Hisaaki Munakata, Kazuyoshi Tajima, Wataru Kato, Keisuke Tanaka, Yoshiyuki Tokuda, Masato Mutsuga, Akihiko Usui

General Thoracic and Cardiovascular Surgery Vol. 68 ( 8 ) page： 768 - 773 2020.8

Management of Patients With Aortic Stenosis Requiring Non-Cardiac Surgery International journal Open Access

Tokuda Yoshiyuki, Usui Akihiko

Circulation Journal Vol. 84 ( 7 ) page： 1064 - 1066 2020.6

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background:Patients with severe aortic stenosis (AS) might be at high risk for adverse cardiovascular events at the time of non-cardiac surgery.Methods and Results:The current study population included 348 patients who underwent elective non-cardiac surgery under general or spinal anesthesia during the follow up of 3,815 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry. There were 187 patients with untreated severe AS at time of surgery (untreated severe AS group) and 161 patients who had undergone aortic valve replacement (AVR) before surgery (prior AVR group), including 23 patients with prophylactic AVR. The primary outcome measure was 30-day mortality after non-cardiac surgery. At 30 days after non-cardiac surgery, 8 patients (4.3%) died in the untreated severe AS group, while no patients died in the prior AVR group (P=0.008). The causes of death were cardiovascular in 6 out of 8 patients. Mortality at 30 days was higher in untreated severe AS patients with AS-related symptoms before surgery than in those without AS-related symptoms (7.2% vs. 3.1%). Higher surgical risk estimates of the non-cardiac surgery incrementally increased the risk of 30-day mortality in patients with untreated severe AS, though the difference was not statistically significant (low-risk: 0%, intermediate-risk: 4.3%, and high-risk: 6.6 %, P=0.46).Conclusions:Symptomatic and asymptomatic severe AS might be associated with higher risk of 30-day mortality if untreated before elective intermediate- and high-risk non-cardiac surgery, while no patient with prior AVR died after elective non-cardiac surgery.

DOI： 10.1253/circj.CJ-20-0437

Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10 000 patients from the Japan Cardiovascular Surgery Database. Reviewed International journal Open Access

Tomonobu Abe, Hiroyuki Yamamoto, Hiroaki Miyata, Noboru Motomura, Yoshiyuki Tokuda, Kazuo Tanemoto, Akihiro Usui, Shinichi Takamoto

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Vol. 57 ( 4 ) page： 660 - 667 2020.4

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: To evaluate the background trends and surgical outcomes for more than 10 000 patients with acute type A dissection in Japan in a recent 8-year period. METHODS: Data on replacement of the ascending aorta and/or aortic arch for acute type A dissection were collected from the Japan Cardiovascular Surgery Database from 2008 to 2015. Linear-by-linear association tests or Cuzick's test for trend was used to evaluate group trends over time. The results were calculated for ascending or hemiarch replacement and arch replacement. A multivariable logistic regression model was used to calculate the risk-adjusted operative mortality rate. RESULTS: A total of 11 843 patients were included. The overall 30-day mortality and operative mortality rates were 7.6% and 9.5%, respectively. The number of surgically treated cases increased from 2436 patients in 2008-2009 to 3533 in 2014-2015, a 45.0% increase. A trend analysis revealed significant changes in patient characteristics with time, including increasing age and rate of preoperative renal failure. Despite worsening risk factors, the unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01; test of trend). The risk-adjusted mortality rate showed a downward trend both in ascending aorta or hemiarch replacement and arch replacement, although the trend was not statistically significant (P > 0.05). CONCLUSIONS: Unadjusted and adjusted operative deaths have shown a decreasing trend, although patients undergoing surgery for acute type A dissection have demonstrated worsening of risk factors, such as age and renal failure. The number of surgeries performed for acute type A dissection significantly increased throughout the study period in Japan.

DOI： 10.1093/ejcts/ezz323

The incidence and risk factors of hypofibrinogenemia in cardiovascular surgery Reviewed International journal

Toshihiko Nishi, Masato Mutsuga, Toshiaki Akita, Yuji Narita, Kazuro Fujimoto, Yoshiyuki Tokuda, Sachie Terazawa, Hideki Ito, Kimitoshi Nishiwaki, Akihiko Usui

General Thoracic and Cardiovascular Surgery Vol. 68 ( 4 ) page： 335 - 341 2020.4

肺高血圧治療部門新規開設施設におけるCTEPHに対するPEA/BPA中期成績の検討 Reviewed International journal

寺澤幸枝, 安藤太三, 足立史郎, 近藤隆久, 石田真一, 矢野大介, 秋田翔, 西俊彦, 芦田真一, 宗像寿祥, 内田亘, 松村泰基, 伊藤英樹, 徳田順之, 六鹿雅登, 藤本和朗, 成田裕司, 碓氷章彦

日本心臓血管外科学会学術総会抄録集 Vol. 50回 page： O11 - 3 2020.3

Spinal cord injury following aortic arch replacement Reviewed International journal

Yoshiyuki Tokuda, Kazuro Fujimoto, Yuji Narita, Masato Mutsuga, Sachie Terazawa, Hideki Ito, Yasumoto Matsumura, Wataru Uchida, Hisaaki Munakata, Shinichi Ashida, Tsukasa Ono, Toshihiko Nishi, Daisuke Yano, Shinichi Ishida, Fumiaki Kuwabara, Toshiaki Akita, Akihiko Usui

Surgery Today Vol. 50 ( 2 ) page： 106 - 113 2020.2

Contemporary Outcomes of Surgical Aortic Valve Replacement in Japan Open Access

Tokuda Yoshiyuki, Yamamoto Hiroyuki, Miyata Hiroaki, Usui Akihiko, Motomura Noboru, The Japan Cardiovascular Surgery Database Organization

Circulation Journal Vol. 84 ( 2 ) page： 277 - 282 2020.1

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background:Given the rapid expansion in the use of transcatheter aortic valve implantation (TAVI), recent outcomes of surgical aortic valve replacement (SAVR) should be re-evaluated.Methods and Results:Using the data from the Japan Cardiovascular Surgery Database of 160 enrolled hospitals, trends in elective isolated SAVR were evaluated until the introduction of TAVI in Japan. Trend analyses were performed over 4 periods: period 1, 2008–2009 (4,415 cases); period 2, 2010–2011 (4,861 cases); period 3, 2012–2013 (5,674 cases); and period 4, 2014–2015 (5,563 cases). Baseline risk, evaluated on JapanSCORE, increased significantly over the 4 periods, from a median of 1.56 (IQR, 0.99–2.61) in period 1 to 2.08 (IQR, 1.33–3.96) in period 4 (P<0.001, trend test). Despite the increased risk, the composite major complication and operative mortality rate decreased significantly (10.7% in period 1 to 9.2% in period 4, P=0.01). Using a risk-adjusted model, the OR of operative mortality was 1.61 (95% CI: 1.29–2.02) in period 1 (P<0.0001) compared with period 4. An increase in the use of bioprostheses was also observed, from 60.4% to 76.8% (P<0.001) over the 4 periods.Conclusions:Even in a short 8-year period, SAVR outcomes improved in Japan. This should be taken into account when discussing the indications for aortic valve intervention.

DOI： 10.1253/circj.CJ-19-0674

Mechanical haemolytic anaemia assessed with four-dimensional flow cardiac magnetic resonance International journal Open Access

Uchida Wataru, Tokuda Yoshiyuki, Takehara Yasuo, Usui Akihiko

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY Vol. 56 ( 4 ) page： 813 - 814 2019.10

Language：English Publishing type：Research paper (scientific journal)

A 66-year-old woman developed marked haemolytic anaemia 2 years after total aortic arch replacement using a branched Dacron graft. Echocardiography confirmed bicuspid aortic valve stenosis. A four-dimensional flow magnetic resonance imaging revealed a jet flow arising from the aortic valve along with the vortex and turbulent flow inside the kinked prosthetic graft at the ascending aorta. She underwent a reoperation to replace the aortic valve and correct the kinking. The estimated energy loss after intervention was relieved to 2.9 mJ/cardiac cycle from 4.3 mJ/cardiac cycle before intervention. The patient's anaemia resolved immediately after the reoperation.

DOI： 10.1093/ejcts/ezz031

Ascorbic acid deficiency increases hepatic expression of acute phase proteins through the intestine-derived IL-6 and hepatic STAT3 pathway in ODS rats. Reviewed International journal

Kawade N, Murai A, Suzuki W, Tokuda Y, Kobayashi M, Horio F

The Journal of nutritional biochemistry Vol. 70 page： 116 - 124 2019.8

Temporary immobile leaflet following transcatheter aortic valve replacement of a SAPIEN-XT valve. Reviewed International journal

Aoki T, Tanaka A, Tokuda Y, Oshima H, Suzuki S, Ishii H

Cardiovascular intervention and therapeutics Vol. 34 ( 3 ) page： 277 - 278 2019.7

Conservative treatment of type A aortic dissection following hybrid arch repair

Yoshizumi Tomo, Tokuda Yoshiyuki, Abe Tomonobu, Usui Akihiko

GENERAL THORACIC AND CARDIOVASCULAR SURGERY Vol. 67 ( 7 ) page： 602 - 607 2019.7

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Type A aortic dissection (TAAD) following hybrid arch repair (HAR) is a lethal complication. Open surgical repair is the ideal treatment, but this can be difficult, as most candidates have complications and are unsuitable for the conventional open aortic repair. We herein report three cases of TAAD after HAR and assess the treatment options. METHODS: Of 261 aortic arch repair cases between April 2010 and March 2018, 38 underwent HAR using debranching of all the arch vessels followed by stent graft implantation landing proximally in zone 0 (type 1 HAR). Three cases suffered from TAAD, and their background characteristics and post-operative outcomes were studied retrospectively. RESULTS: The three TAAD cases were elderly with a high risk of mortality due to comorbidities. TAAD for Cases 1, 2, and 3 was detected on post-operative day (POD) 11, POD11, and during the procedure, respectively. Case 1 was complicated with both respiratory and renal failures, and Case 3 suffered from severe neurological impairment when TAAD was detected. No additional open aortic repair was performed in any cases. Case 3 died on POD5 due to aortic rupture. Cases 1 and 2 have survived for more than 50 months since their initial surgeries. CONCLUSIONS: TAAD following HAR can be detected with post-operative imaging despite a lack of signs noted during the intra- and post-operative periods. Conservative therapy might, therefore, be an acceptable option for subacute-onset TAAD following HAR with stable hemodynamics, even though such patients do required a very careful follow-up.

DOI： 10.1007/s11748-019-01075-w

Neurologic Deficit After Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis Reviewed International journal Open Access

Yoshiyuki Tokuda, Yuji Narita, Kazuro Fujimoto, Masato Mutsuga, Sachie Terazawa, Hideki Ito, Wataru Uchida, Akihiko Usui

The Annals of Thoracic Surgery Vol. 108 ( 1 ) page： 107 - 114 2019.7

Fungal endocarditis after transcatheter aortic valve replacement (TAVR): Case report and review of literature. Reviewed International journal

Morioka H, Tokuda Y, Oshima H, Iguchi M, Tomita Y, Usui A, Yagi T

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 25 ( 3 ) page： 215 - 217 2019.3

Language：English Publishing type：Research paper (scientific journal)

The reported number of transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) cases has been increasing worldwide, but information about the incidence and clinical features of fungal TAVR-IE is quite limited. We present a patient who acquired TAVR-IE caused by Candida parapsilosis four month after TAVR, who was successfully treated redo-aortic valve replacement and prolonged antifungal therapy.

DOI： 10.1016/j.jiac.2018.08.017

Dementia and Cognitive Impairment on Coronary Artery Bypass Grafting Patients in Aging Society International journal

Terazawa Sachie, Narita Yuji, Fujimoto Kazuro, Mutsuga Masato, Tokuda Yoshiyuki, Ito Hideki, Uchida Wataru, Usui Akihiko

Journal of Coronary Artery Disease Vol. 25 ( 3 ) page： 66 - 71 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Coronary Association

Coronary artery bypass grafting (CABG) is strategy for complex coronary artery disease (CAD) practiced worldwide that has become to be performed in relatively elderly patients in recent years, regarding to the development of off-pump CABG. As the population of elderly patients with cognitive disorders increases, a certain proportion of CABG candidates are likely to have some degree of cognitive impairment, especially dementia. The discussions about the CABG candidates with dementia are still insufficient, although several reports have suggested that 9.6%&ndash20% of CABG candidates may have preoperative dementia. An analysis indicated higher rate of hospital mortality and delirium in dementia patients, but ideal strategies for managing such patients remain controversial. An estimated 20%&ndash35% of CABG patients may have preoperative mild cognitive impairment (MCI), which is associated with an increased risk of morbidity and poor physical recovery after CABG. This preoperative cognitive decline was identified as a predictive factor for post-operative cognitive decline (POCD). Several randomized control trial have compared the cognitive outcomes between elderly high-risk patients after CABG with or without cardiopulmonary bypass, finding no significant cognitive differences between on- and off-pump treatments at 3 to 12 months after CABG. In addition, any late cognitive decline is likely associated with the progression of underlying cerebrovascular disease rather than surgical procedure itself or cardiopulmonary bypass. Preoperative evaluations of the cognitive function may contribute to appropriate postoperative management, reduce the incidence of delirium and improve the overall surgical outcome.

DOI： 10.7793/jcad.25.010

CiNii Research

The oral administration of clarithromycin prevents the progression and rupture of aortic aneurysm. Reviewed International journal Open Access

Uchida W, Narita Y, Yamawaki-Ogata A, Tokuda Y, Mutsuga M, Lee Fujimoto K, Abe T, Oshima H, Usui A

Journal of vascular surgery Vol. 68 ( 6S ) page： 82S - 92S.e2 2018.12

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: The pathogenesis of aortic aneurysm (AA) is associated with chronic inflammation in the aortic wall with increased levels of matrix metalloproteinases (MMPs). Clarithromycin (CAM) has been reported to suppresses MMP activity. In this study, we investigated whether CAM could prevent the formation and rupture of AA. METHODS: Male apolipoprotein E-deficient mice (28-30 weeks of age) were infused with angiotensin II for 28 days. CAM (100 mg/kg/d) or saline (as a control) was administered orally to the mice every day (CAM group, n = 13; control group, n = 13). After the administration period, the aortic diameter, elastin content, macrophage infiltration, MMP levels, and levels of inflammatory cytokines, including nuclear factor κB (NF-κB), were measured. RESULTS: The aortic diameter was significantly suppressed in the CAM group (P < .001). No rupture death was observed in the CAM group in contrast to five deaths (38%) in the control group (P < .01). CAM significantly suppressed the degradation of aortic elastin (56.3% vs 16.5%; P < .001) and decreased the infiltration of inflammatory macrophages (0.05 vs 0.16; P < .01). Compared with the controls, the enzymatic activity of MMP-2 and MMP-9 was significantly reduced in the CAM group (MMP-2, 0.15 vs 0.56 [P < .01]; MMP-9, 0.12 vs 0.60 [P < .01]), and the levels of interleukin 1β (346.6 vs 1066.0; P < .05), interleukin 6 (128.4 vs 346.2; P < .05), and phosphorylation of NF-κB were also decreased (0.3 vs 2.0; P < .01). CONCLUSIONS: CAM suppressed the progression and rupture of AA through the suppression of inflammatory macrophage infiltration, a reduction in MMP-2 and MMP-9 activity, and the inhibition of elastin degradation associated with the suppression of NF-κB phosphorylation.

DOI： 10.1016/j.jvs.2017.12.047

Strategy of Cardiovascular Surgery for Patients With Dementia as Evaluated by Mini-Mental State Examination. International journal Open Access

Terazawa S, Oshima H, Narita Y, Fujimoto K, Mutsuga M, Tokuda Y, Yoshizumi T, Ito H, Uchida W, Usui A

Circulation journal : official journal of the Japanese Circulation Society Vol. 82 ( 12 ) page： 2998-3004 - 3004 2018.11

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background: The strategy for cardiovascular surgery in dementia patients is controversial, so we aimed to investigate whether preoperative dementia and its severity might affect the outcomes of cardiovascular surgery by evaluating with the Mini-Mental State Examination (MMSE). Methods and Results: The study group comprised 490 patients undergoing cardiovascular surgery. Their preoperative cognitive status was evaluated using the MMSE, and analysis was performed to compare the patients with MMSE score <24 (dementia group, n=51) or MMSE score 24–30 (non-dementia group, n=439). Furthermore, the effect of the severity of dementia was analyzed with a cut-off MMSE score of 19/20. Risk factors for surgical outcomes were explored using multivariate logistic regression analysis. Hospital mortality was 11.8% in the dementia group and 2.1% in the non-dementia group (P=0.002). Regarding the postoperative morbidities, the incidence of cerebrovascular disorder (P=0.001), pneumonia (P=0.039), delirium (P=0.004), and infection (P=0.006) was more frequent in dementia group. Among the patients with MMSE <20, hospital mortality was as high as 25%, and the rate of delirium was 58%. Multivariate logistic regression analysis revealed that MMSE score <24 (P=0.003), lower serum albumin (P=0.023) and aortic surgery (P=0.036) were independent risk factors for hospital death. Conclusions: Preoperative dementia affects the outcomes of cardiovascular surgery with regard to hospital death and delirium. The surgical indication for patients with MMSE <20 might be difficult, but surgery with an appropriate strategy should be considered for patients with MMSE <24.

DOI： 10.1253/circj.CJ-18-0312

The Possibility of Clarithromycin for the Treatment of Type B Aortic Dissection.

Uchida Wataru, Yamawaki-Ogata Aika, Hideki Ito, Sachie Tarazawa, Tokuda Yoshiyuki, Mutsuga Masato, Fujimoto Kazuro L., Yuji Narita, Usui Akihiko

CIRCULATION Vol. 138 2018.11

Aortic sarcoidosis complicated by a pulmonary artery aneurysm. Reviewed International journal Open Access

Uchida W, Tokuda Y, Mutsuga M, Usui A

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Vol. 54 ( 4 ) page： 786 - 788 2018.10

Placebo-Controlled, Double-Blinded Phase III Study Comparing Dexamethasone on Day 1 With Dexamethasone on Days 1 to 3 With Combined Neurokinin-1 Receptor Antagonist and Palonosetron in High-Emetogenic Chemotherapy. Reviewed International journal

Ito Y, Tsuda T, Minatogawa H, Kano S, Sakamaki K, Ando M, Tsugawa K, Kojima Y, Furuya N, Matsuzaki K, Fukuda M, Sugae S, Ohta I, Arioka H, Tokuda Y, Narui K, Tsuboya A, Suda T, Morita S, Boku N, Yamanaka T, Nakajima TE

Journal of clinical oncology : official journal of the American Society of Clinical Oncology Vol. 36 ( 10 ) page： 1000 - 1006 2018.4

Clinical outcomes and quality of life after surgery for dilated ascending aorta at the time of aortic valve replacement; wrapping versus graft replacement Reviewed International journal Open Access

Tomonobu Abe, Sachie Terazawa, Hideki Ito, Yoshiyuki Tokuda, Kazuro Fujimoto, Masato Mutsuga, Yuji Narita, Hideki Oshima, Akihiko Usui

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 79 ( 4 ) page： 443 - 451 2017.11

Language：English Publishing type：Research paper (scientific journal) Publisher：NAGOYA UNIV, SCH MED

Wrapping and graft replacement are two optional procedures for the treatment of dilated ascending aorta at the time of aortic valve replacement (AVR). Wrapping is considered less invasive. The aim of this study was to compare the short-and long-term clinical outcomes as well as the long-term quality of life in patients undergoing these two procedures. This study enrolled 40 consecutive patients with dilated ascending aorta who had undergone either wrapping (WAA group, n=20) or replacement (RAA group, n=20) of the ascending aorta at the time of AVR. Short-term outcomes, long-term deaths, and aortic events were evaluated, as was quality of life using the SF-36 Short Form. Long-term maximal proximal aortic diameter was also obtained. There were no early deaths in either group. Pump time was shorter, and transfusion (55% vs. 95%, p=0.035) and postoperative atrial fibrillation (5% vs. 30%, p=0.036) rates were lower, in the WAA than in the RAA group. At a mean follow-up of 4.9 years, the overall 5 year survival rates in the WAA and RAA groups were 78.1% and 87.5%, respectively. There were no significant between group differences in SF-36 scores in any subcategory of this survey. Long-term maximal aortic diameter remained stable in both groups. Both surgical interventions for dilated ascending aorta at the time of AVR yield favorable and comparable results in patients with suitable anatomy. Furthermore, we found no differences in quality of life between these procedures.

DOI： 10.18999/nagjms.79.4.443

Entire Circumferential Reconstruction of the Right Atrium Surrounded by Angiosarcoma Reviewed International journal

Makoto Hibino, Tomonobu Abe, Hideki Oshima, Yuji Narita, Masato Mutsuga, Kazuro L. Fujimoto, Yoshiyuki Tokuda, Koji Yamana, Taiyo Kuroda, Akihiko Usui

ANNALS OF THORACIC SURGERY Vol. 103 ( 6 ) page： e483 - e485 2017.6

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

Primary cardiac angiosarcomas are frequently found at a large size with infiltration into the adjacent heart structure owing to their asymptomatic characteristics until an advanced stage. Therefore, extensive resection is often required to achieve a good prognosis. We herein report a case of entire circumferential resection of the right atrium surrounded by angiosarcoma and excellent three-dimensional reconstruction of the right atrium. (C) 2017 by The Society of Thoracic Surgeons.

DOI： 10.1016/j.athoracsur.2016.11.032

Total Arch Replacement Using Manufactured Frozen Elephant Trunk after Acute Type-A Dissection Repair

Hibino M., Mutsuga M., Oshima H., Narita Y., Abe T., Fujimoto K., Tokuda Y., Usui A.

Kyobu geka. The Japanese journal of thoracic surgery Vol. 70 ( 4 ) page： 281 - 285 2017.4

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Kyobu geka. The Japanese journal of thoracic surgery

The purpose of this study is to assess the result of total arch replacement(TAR) using manufactured frozen elephant trunk(FET) for chronic aortic dissection after initial repair including the effect of aortic remodeling by the FET. Between 2003 and 2015, we performed 11 TAR using manufactured FET. Initial repairs before were 9 ascending aortic replacements and 2 Bentall operations. The entry of residual dissection was located at arch in 7 and at distal anastomosis site in 4. There was no hospital death. The operative complication included 2 surgical site infection, 1 interstitial pneumonia and 1 paraplegia with almost full recovery. Postoperative computed tomography 2.1 months after operation showed distal end of the FET was located at aortic valve level in 7 and at pulmonary bifurcation level in 4. There was no entry in thoracic aorta. Thrombosis of descending aorta was achieved in 7 patients. Significant midterm aortic remodeling (increased diameter of true lumen and decreased diameter of false lumen) was achieved, although the total diameter of aorta was increased. TAR using manufactured FET after type-A dissection repair promoted entry closure and thrombosis of false lumen. It requires long-term observation to judge the effect for aortic remodeling.